Tobacco Atlas Shows Shifting U.S. Health Gaps

The U.S. Tobacco Atlas reveals that cigarette smoking rates have dropped across the country. The latest data show these numbers:

Marginalized groups face higher tobacco use and lower success when quitting. These gaps create serious health problems and show that current policies do not reach everyone. The Atlas gives public health leaders and policymakers the facts they need and urges stronger, fairer tobacco control efforts to protect all communities.

Key Takeaways

• Cigarette smoking rates in the U.S. have significantly decreased, with adult smoking dropping from 21.2% in 2011 to 12.1% in 2023.

• Marginalized groups experience higher tobacco use and face greater challenges in quitting, highlighting the need for targeted public health policies.

• E-cigarette use is rising, especially among youth, with 1.63 million young people using e-cigarettes in 2023, raising new concerns for tobacco control.

• Secondhand smoke exposure has decreased, but it still poses serious health risks, particularly for low-income and less educated individuals.

• Stronger tobacco control policies, including smoke-free laws and higher taxes, are essential to reduce tobacco-related harm and health disparities.

U.S. Tobacco Atlas Overview

Purpose and Structure

The U.S. Tobacco Atlas launched as a new resource for public health. The creators designed it to raise awareness and influence policy about tobacco’s impact on health, politics, and business. The Atlas uses both a print edition and a companion website. The website helps more people access information and see updated research and graphs. The American Cancer Society and Vital Strategies worked together to build the Atlas. They wanted to turn complex data into stories that people can understand. The Atlas uses illustrations to show the serious problems caused by tobacco. These images help readers see the real effects of tobacco use.

The Atlas presents information in a clear way. The print edition highlights key facts and figures. The website gives users more details and new research. The team behind the Atlas believes that sharing data in different formats helps more people learn and take action.

The U.S. Tobacco Atlas combines strong visuals and easy-to-read data to make tobacco issues clear for everyone.

Key Audiences

The U.S. Tobacco Atlas speaks to many groups. Policymakers use the Atlas to guide decisions and create better laws. Public health leaders rely on the Atlas to plan programs and track progress. Teachers and students find the Atlas helpful for learning about tobacco’s impact. Community groups use the Atlas to support local efforts and raise awareness. The Atlas also reaches people who want to quit tobacco or help others stop. By sharing facts and stories, the Atlas encourages everyone to take action against tobacco use.

Tobacco Use Trends

Declining Smoking Rates

Cigarette smoking in the United States has dropped sharply over the past decade. The U.S. Tobacco Atlas shows that adult smoking rates fell by 43% from 2011 to 2023, moving from 21.2% to 12.1%. This decline happened in every state. The largest drops appeared in the District of Columbia and Rhode Island. Middle and high school students also smoked less. From 2011 to 2021, middle school smoking dropped by 50%, and high school smoking fell by 55%.

Public health policies helped drive these changes. Excise taxes and smoke-free air laws made a big difference. For example, between 2011 and 2013, the average adult smoking rate dropped from 21.3% to 19.3%. These laws made it harder to smoke in public and raised the cost of cigarettes.

Smoking rates differ by age and group. Adults aged 45–64 have the highest cigarette smoking rates. Non-Hispanic American Indian or Alaska Native adults, people with disabilities, and those with severe mental health issues smoke more than other groups. The U.S. Tobacco Atlas points out that men smoke more than women, but both groups have seen declines.

Smoking rates have dropped, but millions of Americans still smoke. Many belong to groups that face more health risks and less support.

E-Cigarette and Alternative Product Use

While cigarette smoking has gone down, e-cigarette use has gone up, especially among young people. In 2022, about 825,000 more children used e-cigarettes. Young adults aged 18–24 use e-cigarettes the most. In 2023, 15.5% of young adults (ages 21–24) used e-cigarettes, compared to 6.5% of all adults.

Youth e-cigarette use is a growing concern. In 2023, 1.63 million youth used e-cigarettes. High school students had a use rate of 7.8%, while middle school students had a rate of 3.5%. Many students use flavored products, and over one-third use e-cigarettes on most days.

E-cigarette use also varies by race and ethnicity. Non-Hispanic American Indian or Alaska Native youth have the highest rates at 11.5%. Many students use more than one tobacco product. High school students report a 36.6% rate of using multiple products.

The rise in e-cigarette use among youth and young adults presents a new challenge for tobacco control efforts.

Secondhand Smoke Exposure

Secondhand smoke remains a serious health risk. Over the last decade, fewer nonsmoking adults have been exposed to secondhand smoke. The percentage dropped from 27.7% in 2009–2010 to 20.7% in 2017–2018.

• Secondhand smoke contains over 7,000 chemicals, including about 70 known to cause cancer.

• Breathing in secondhand smoke can lead to lung cancer, heart disease, and stroke.

• Each year, more than 19,000 deaths in the U.S. are linked to secondhand smoke.

• Children exposed to secondhand smoke face higher risks for asthma attacks, respiratory infections, and sudden infant death syndrome (SIDS).

Disparities in exposure still exist. People with lower income or less education are more likely to be exposed. The U.S. Tobacco Atlas highlights that, even with progress, secondhand smoke continues to harm many Americans.

Reducing secondhand smoke exposure saves lives and improves health for everyone.

Health Impacts and Screening

Cancer and Tobacco

Tobacco use causes more cancer deaths than any other preventable factor in the United States. Over 80% of lung cancer deaths link directly to smoking. In 2023, smoking rates dropped to 11%, but tobacco still accounts for about 30% of all cancer deaths each year. The U.S. Tobacco Atlas reports that tobacco leads to 480,000 deaths annually. Doctors diagnose 660,000 new tobacco-related cancer cases every year, and 343,000 people die from these cancers.

Lung Cancer Screening Gaps

Lung cancer screening saves lives, but many people miss out. In 2021, only 5.8% of eligible Americans received a lung cancer screening. Massachusetts had the highest rate at 16.3%. California and Nevada had rates below 2%. More than 40% of lung cancer cases are found late, and survival drops below 9%. Annual low-dose CT scans can lower lung cancer deaths by 20% for high-risk groups.

• Current guidelines may not include many racial minorities, which leads to fewer screenings.

• Simplified rules could help more Black and white people qualify for screening.

• Over 14 million Americans qualify for screening, but many do not know about it.

• In one study, only 43% of Black women with lung cancer qualified for screening.

• Most people who qualify do not get screened, often because they lack awareness or access.

Smoking Cessation Challenges

Quitting smoking remains difficult for many Americans. Several barriers stand in the way:

• Cultural norms in addiction treatment centers support smoking.

• Many clients feel unready to quit.

• Clinics often lack resources for nicotine replacement therapy and staff training.

• Staff members who smoke may influence clients.

• Tobacco outlets near treatment centers make quitting harder.

"One of the barriers is that behavioral health clinicians are not really… schooled and trained to address nicotine addiction in that context. So it’s not part of the culture."

Successful interventions include advice from healthcare providers, workplace programs, media campaigns, and technology-based tools.

Disparities and Policy Gaps

Marginalized Populations

Many marginalized groups in the United States face higher risks from tobacco. Systemic inequities make it harder for these communities to avoid tobacco use and get help to quit. The tobacco industry often targets low-income and diverse neighborhoods with advertising and promotions. Limited access to healthcare resources means fewer opportunities for prevention and treatment. Social factors like education and discrimination also increase tobacco use risk.

• People with low socioeconomic status struggle to get healthcare and manage smoking-related health problems.

• Uninsured individuals miss out on screenings and care, which leads to worse health outcomes.

• Delays in healthcare due to low income cause more health complications.

• Web-based quitlines and FDA-approved cessation medications are less accessible to racial and ethnic minorities.

Regional Differences

Tobacco use and health impacts vary across regions and communities. Black Americans have similar smoking rates to white Americans, but menthol cigarette use is much higher among Black Americans (88.5% vs. 29%). Death rates from tobacco-related diseases are also higher in Black communities. The tobacco industry has a history of targeting Black, Brown, and Indigenous peoples with menthol marketing and cultural exploitation.

State-level policies show big gaps. Tobacco Nation states have higher smoking rates and weaker tobacco control laws. These states spend less on prevention and have lower cigarette prices and excise taxes.

Policy Needs and Solutions

Stronger and fairer tobacco control policies can help close these gaps. Many governments have not adopted all recommended measures, such as comprehensive smoke-free laws and higher taxes. Regulations on nicotine and flavored tobacco products remain weak in many areas. Experts recommend several solutions:

• Implement smoke-free policies in all public indoor spaces and workplaces.

• Limit nicotine levels in tobacco products.

• Ban flavored tobacco, including menthol, to protect youth and vulnerable groups.

• Control the number and location of tobacco stores in high-risk areas.

• Raise tobacco prices and remove discounts.

• Expand support for quitlines and cessation resources.

• Launch educational campaigns for all communities.

Equitable policies and strong enforcement can reduce tobacco-related harm and save lives.

The U.S. Tobacco Atlas shows that strong leadership and new policies remain urgent to reduce tobacco-related harm and health disparities. Experts recommend actions such as removing flavored tobacco, increasing federal investment, improving access to treatment, and promoting research.

Advocates, health experts, and governments must work together. The Atlas highlights the need for collaboration and comprehensive tobacco control. Communities can pool resources, create tailored plans, and drive change. Collective action offers hope to end the tobacco epidemic.

FAQ

What is the U.S. Tobacco Atlas?

The U.S. Tobacco Atlas is a resource that shows data about tobacco use, health impacts, and policies. The American Cancer Society and Vital Strategies created it to help people understand tobacco issues.

Who uses the U.S. Tobacco Atlas?

Policymakers, health leaders, teachers, and community groups use the Atlas. They rely on it to guide decisions, plan programs, and teach others about tobacco risks.

Why do some groups have higher tobacco use?

Many marginalized groups face more tobacco advertising and have less access to healthcare. Social and economic factors make quitting harder for these communities.

The Atlas highlights these disparities and urges action to support all groups.

How can people quit smoking?

People can quit smoking with help from doctors, quitlines, and support programs. Nicotine replacement therapy and counseling increase success rates. Technology-based tools also help many people stop using tobacco.

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